Patients Undergoing Capsule Endoscopy Research Articles

PD peritonitis in patients undergoing capsule endoscopy: A descriptive study.

Peritoneal dialysis (PD) patients who undergo gastroendoscopy and colonoscopy are at increased risk of peritoneal dialysis-associated peritonitis (PD peritonitis) following the procedure (defined as occurring within 7 days of intervention). As per current International Society for PD (ISPD) guidelines, antibiotic prophylaxis is currently recommended pre-colonoscopy in PD patients given the risk of post-colonoscopy PD peritonitis. The risk of PD peritonitis in patients undergoing capsule endoscopy (CE) is unknown. This binational data-linkage study between the Australia and New Zealand Dialysis and Transplant Registry and all hospital admission data sets in Australia and New Zealand evaluated all patients with PD who underwent CE between 2006 and 2015. The objective of the study was to assess the risk of PD peritonitis in patients undergoing CE. Descriptive statistics were used to describe patient characteristics and clinical outcomes. Overall, 23 patients with PD underwent CE. Twelve patients underwent CE alone (i.e. no other concomitant procedures) and none of these patients experienced an episode of PD peritonitis. The remaining 11 patients underwent CE and other invasive endoscopic/abdominal surgical procedures, of whom 2 suffered PD peritonitis. CE is likely a relatively safe procedure in PD patients. PD patients undergoing CE may not require prior antibiotic prophylaxis. Given their relative safety, CE may be an appealing diagnostic tool in a select group of PD patients for the investigation of gastrointestinal disease.

Clinical profile associated with bleeding small bowel tumors in patients undergoing capsule endoscopy

Clinical profile associated with bleeding small bowel tumors in patients undergoing capsule endoscopy

Efficacy and safety of capsule endoscopy in octogenarian patients: a retrospective study.

Life expectancy and the number of ultra-octogenarians increased significantly, thus making crucial the appropriateness of several endoscopic procedures in elderly patients. The aim of our study was to provide a retrospective analysis of the efficacy and safety of capsule endoscopy (CE) in patients aged over 80 years. In this single-centre study, 900 patients underwent capsule endoscopy between 2002 and 2015 for different indications; of these 106 patients aged ≥80 years (group A) and 99 patients aged 40-60 years (control group B) were retrospectively selected. Occult gastrointestinal bleeding accounted for 62.1% of all indications for capsule endoscopy in group B, compared to 95.2% in group A (P<0.001). Although not statistically significant, the diagnostic yield was higher in group A (71%) vs. group B (62%). The percentages of reaching the cecum and the median gastric transit time were uniform within the two groups. In contrast, small bowel transit time was longer in group A vs. B. Small bowel preparation was similar in the two groups. The exam was generally well tolerated in both groups, with capsule aspiration being one of the main adverse events, which occurred in two elderly patients. Our data expand previous findings confirming that capsule endoscopy can be performed safely even in very old patients and show that the diagnostic yield is similar to that of younger patients.

Lewis score on capsule endoscopy can predict the prognosis in patients with small bowel lesions of Crohn's disease.

Endoscopic evaluation of disease activity, including mucosal healing, is poorly established in Crohn's disease. We previously reported that patients with a Lewis score (LS) on capsule endoscopy <270 had a lower risk of exacerbation without additional treatment. This study investigated prognostic predictors in patients undergoing capsule endoscopy and determined the optimal LS cut-off value. In a retrospective single-center study, 102 patients with Crohn's disease who underwent capsule endoscopy were reviewed. We reviewed the clinical course and the patients' characteristics, Crohn's Disease Activity Index, laboratory findings, LS, and Prognostic Nutritional Index (PNI) for factors potentially associated with Crohn's disease-related emergency hospitalization. Subsequently, we prospectively enrolled 66 patients with Crohn's disease and analyzed clinical outcomes according to these factors. In the retrospective study, LS≥270 and PNI<45 were identified as independent predictors of Crohn's disease-related emergency hospitalization with hazard ratios of 9.48 and 3.01, respectively. Even in patients with LS≥270, cumulative hospitalization rates decreased after intervention based on capsule endoscopy findings. The prospective study confirmed that patients with LS≥270 or PNI<45 had a significantly higher risk of Crohn's disease-related emergency hospitalization and that additional treatment reduced the risk of relapse. LS and PNI are the best available prognostic predictors in patients with Crohn's disease without gastrointestinal stenosis and can guide decisions on treatment escalation. Patients with LS≥270 and PNI<45 were at increased risk for exacerbation, and additional treatments should be considered for this group.

S1852 Retrograde Balloon-Assisted Deep Enteroscopy in the Diagnosis of Metastatic Melanoma

INTRODUCTION: A 74 year old male with past medical history of melanoma, presents to clinic due to persistently abnormal small bowel findings on PET-CT scan. The following case illustrates a unique and unusual case of metastatic gastrointestinal disease, and the utility of both capsule endoscopy and balloon-assisted deep enteroscopy to assist in the diagnosis of metastatic melanoma. CASE DESCRIPTION/METHODS: A 74 year old male with past medical history of previously excised melanoma in remission presented to clinic due to persistently abnormal small bowel findings on surveillance PET-CT scan. Patient reported feeling well. Over the last 2 years, multiple PET scans had shown intense focal FDG uptake in distal small bowel, deemed to be inflammatory in nature although melanoma recurrence remained a possibility. Given recurrent findings, patient underwent capsule endoscopy which revealed ulcerated, nodular, and erythematous mucosa likely in distal ileum. Patient underwent retrograde double balloon enteroscopy which showed ulcerated, edematous mucosa in distal ileum at 95 cm from ileocecal valve, with biopsies consistent with metastatic melanoma as confirmed by the presence of melanin in tumor biopsy and positive staining. The site of the lesion was marked with SPOT Tattoo to allow for intraoperative localization. Patient underwent surgical resection which revealed second area of ileal metastasis, which was safely resected. DISCUSSION: The following case illustrates the utility of capsule endoscopy to identify small bowel metastasis; an atypical use in the current practice of capsule endoscopy. This case details how retrograde double balloon enteroscopy, in combination with diagnostic modalities such as PET scans and capsule endoscopy, can assist in the diagnosis of distal small bowel disease including metastasis. This case also illustrates how SPOT tattoo utilization may assist with intraoperative surgical localization of suspicious lesions. While metastatic melanoma in the small intestine is a well-described phenomenon, small bowel metastasis has been detected clinically in only 2%–5% of patients with malignant melanoma. Although these lesions are typically resected surgically for diagnosis, our case illustrates the role of initial small bowel endoscopic imaging to assist in localization to facilitate intraoperative management, and that the combination of capsule endoscopy and retrograde double balloon enteroscopy is a practical and feasible method to evaluate for metastatic disease in the distal small bowel.Figure 1.: Area of ulcerated, nodular, erythematous and congested mucosa seen on Capsule Endoscopy.Figure 2.: Area of ulcerated, nodular, erythematous and congested mucosa seen on Capsule Endoscopy.Figure 3.: Area of ulcerated, erythematous and congested mucosa identified on Retrograde Deep Balloon Enteroscopy.

Opioid Use Is Associated With Incomplete Capsule Endoscopy Examinations: A Meta-Analysis and Systematic Review

Introduction: Capsule endoscopy (CE) is a non-invasive imaging modality designed with the purpose of evaluating the small bowel, prominently in the setting of evaluation for obscure gastrointestinal (GI) bleeding. Incomplete examination, which is defined as failure to reach the cecum within the battery lifespan, may result in inadequate diagnosis of small bowel pathologies which can lead to delayed intervention or repeated studies. Opioid medications have been previously shown to affect GI motility. Several studies have attempted to evaluate the association between CE completion and opioid use with contradicting results. The aim of this meta-analysis is to evaluate the previously published studies on the association between opioid use and CE completion. Methods: A systemic review was conducted in PUBMED, Embase, Pubmed Central and ScienceDirect databases from inception through June 2018 to identify the studies that evaluated the association between CE completion and opioid use. We used the following keywords in different combinations: “Capsule”, “Endoscopy”, “Opioids”, “Narcotics”. Effect estimates from the individual studies were extracted and combined using the random-effect, generic inverse variance method of DerSimonian and Laird and a pooled odds ratio (OR) was calculated. Forest plots were generated, and publication bias was assessed for using conventional techniques.1158 Figure 1. Forest Plot showing relationship between opioid use and capsule endoscopy completionResults: Five studies with a total of 1614 patients undergoing capsule endoscopy in the inpatient and outpatient setting were included in this study, 349 of whom had an incomplete CE (21.6%). The pooled OR for CE completion is 0.50 (95%CI: 0.38-0.66, I2=36.9%) in opioid users compared to non-users. We found no publication bias as assessed by the funnel plot. Conclusion: Our results indicate that patients on opioids are 50% less likely to have a complete CE examination compared to those not on opioids. To our knowledge, this study represents the first metaanalysis to assess this association. Future prospective randomized research is needed to confirm this association.

Indications for and diagnostic yield of capsule endoscopy in the elderly

Introduction And AimsThe growing elderly population and wide use of capsule endoscopy have led to a higher number of procedures in those patients. The aim of the present study was to assess the usefulness of capsule endoscopy in older patients. Materials And MethodsAll consecutive patients undergoing capsule endoscopy at our center within the time frame of 2004-2016 were classified as older (≥75 years of age) and younger. Findings and diagnostic yield were comparatively assessed. ResultsOf 2311 patients (mean age: 59.5 ± 19.23 years, 44.48% male), 648 were in the older group and 1663 in the younger group. Gastric transit time was shorter in the older patients (p=0.001), whereas small bowel transit time was shorter in the younger patients (p<0.001). Overall diagnostic yield in the elderly was higher (50.66% vs. 41.19%, p<0.001). Obscure gastrointestinal bleeding was the most frequent indication for capsule endoscopy in the elderly (90.4% vs. 53.77%, p<0.001), achieving a higher diagnostic yield than in the younger population (51.47% vs. 42.76%, p=0.002), whereas Crohn's disease, suspected or known neoplasms/polyps, malabsorption syndrome, and abdominal pain were the indications in the younger patient group. Such indications were rare in the older group. Vascular lesions and active bleeding were more frequently diagnosed in the older patients, whereas ulcers/erosions and mucosal atrophy were more common in the younger patients (p<0.001). ConclusionsCapsule endoscopy achieved a higher overall diagnostic yield in the elderly patients. Obscure gastrointestinal bleeding indication for capsule endoscopy was much more frequent in the advanced-age group and had a higher diagnostic yield.

Presence of Melena in Obscure Gastrointestinal Bleeding Predicts Bleeding in the Proximal Small Intestine

Melena is a symptom of upper gastrointestinal bleeding and usually indicates bleeding proximal to the ligament of Treitz. However, whether melena predicts bleeding in the proximal small intestine in patients with obscure gastrointestinal bleeding (OGIB) is unknown and the objective of this study. A retrospective cohort study of consecutive patients undergoing capsule endoscopy for OGIB between July 2009 and May 2016 was conducted. Subjects were categorized based on the presence of melena, and the primary outcome was identification of a bleeding source within the proximal 2/3 of the small intestine. Multi-variable regression was performed to control for confounders. During the study, 288 patients met the eligibility criteria. Subjects with melena accounted for 37.1% of the cohort and were more likely to be older (mean age 66.9 vs. 63.9, p = 0.0457), take warfarin (15.1 vs. 9.4%, p = 0.0122), and have a lower 12-month hemoglobin nadir (7.3 vs. 8.3g/dL, p = 0.0002). On crude analysis, 56.1% of patients with melena had a bleeding source within the proximal small intestine compared to 34.8% for those without (RR 1.61, 95% CI 1.24-2.09, p = 0.0004). On multi-variable analysis, the presence of melena doubled the odds of finding a bleeding site within the proximal small intestine (OR 1.97, 95% CI 1.17-3.33, p = 0.010). The presence of melena doubles the odds of finding a bleeding site within the proximal small intestine among patients with OGIB, and deep enteroscopy, if performed before a capsule study, should begin with an antegrade approach in these patients.

Elevated Faecal Calprotectin Levels are a Reliable Non-Invasive Screening Tool for Small Bowel Crohn’s Disease in Patients Undergoing Capsule Endoscopy

Background: Approximately 10% of Crohn’s disease (CD) patients have this disease affecting the small bowel (SB) beyond the reach of Ileo-colonoscopy. Capsule endoscopy (SBCE) is the recommended investigation for SB disease. An accurate and inexpensive biomarker would help identify at-risk patients. Aim: To examine the efficacy of faecal calprotectin (FC) and C-reactive protein (CRP) as predictors of SBCE findings in suspected and known CD. Methods: A prospective observational study. Consecutive patients referred for SBCE gave FC and CRP samples. The diagnostic accuracy for SB CD based on SBCE result was calculated for both FC and CRP. Results: Of 100 invitees, FC and SBCE results were available in 64 cases. Correlation between FC >50 µg/g and SBCE result was poor К = 0.163; sensitivity, specificity, positive predictive value (PPV) and negative predictive values for ileitis were 60, 61, 32 and 83% respectively. PPV and specificity improved at FC >100 µg/g, 76 and 40%, correlation remained fair, К = 0.259. Receiver operating characteristic analysis had a sensitivity of 47% and specificity of 90% for FC >194 µg/g. CRP alone or in combination was an inaccurate predictor of ileitis. Conclusion: Our study suggests that FC level >194 µg/g may be a useful SBCE filter test, identifying patients at risk of SB CD.

Increased diagnostic yield of small bowel tumors with PillCam: the role of capsule endoscopy in the diagnosis and treatment of gastrointestinal stromal tumors (GISTs). Italian single-center experience.

Gastrointestinal stromal tumors (GISTs) are rare tumors, accounting for 1-3% of all gastrointestinal malignancies; they are, however, the most common gastric and small bowel mesenchymal tumors. The length and relative inaccessibility of the small bowel have long constrained the diagnosis of GISTs mainly presenting with chronic or intermittent bleeding as the sole clinical manifestation. To report on the prevalence of small bowel GISTs in a prospectively recorded series of patients undergoing capsule endoscopy (CE). Between 2001 and 2007 five hundred patients were referred to our endoscopy unit for small bowel evaluation with capsule endoscopy. We retrospectively evaluated all charts. The main indications for CE were obscure-occult or obscure-overt bleeding. Two hundred eighty-nine patients underwent CE for either obscure-occult or obscure-overt bleeding and 211 for other indications. Patient outcome and care processes were measured by follow-up telephone interviews and chart review. Statistical computations were performed using Fisher's exact test and Student's t-test. CE identified a small bowel tumor in 20 patients (4.0%) and 9 tumors turned out to be GISTs (45.0%). Traditional endoscopic and radiological imaging failed to detect the GIST in all these cases. In one case a small bowel GIST was diagnosed by angiography and CE proved false negative. Overall, CE was able to diagnose a small bowel GIST in 9 out of 10 cases. All patients underwent surgical treatment and showed normalized hemoglobin levels at follow-up. The main limitation of this study is the small number of cases. CE is an effective and sensitive diagnostic device compared with conventional radiology and plays an important role in the algorithm for the diagnostic work-up of suspected small bowel tumors.

Small bowel malignancy in patients undergoing capsule endoscopy at a tertiary care academic center: Case series and review of the literature.

Background and study aims Small bowel cancer is rare, accounting for < 5 % of all gastrointestinal neoplasms. Capsule endoscopy has become the procedure of choice for non-invasive diagnosis of small bowel diseases. Data on capsule endoscopy diagnosis of small bowel cancer are limited. The objective of the study was to determine the frequency, indications and diagnostic work-up of patients with small bowel malignancy found by capsule endoscopy at a Scottish tertiary center. Patients and methods In this retrospective study, records all patients who underwent small bowel capsule endoscopy at our center over a 10-year period were reviewed for possible malignancy. Further data were gathered on preceding and subsequent investigations, management and outcome of these patients. Results From 1949 studies, small bowel malignancies were diagnosed in only 7 patients (0.36 %; 2F/5M; median age 50, range 34 – 67). The main indication was iron-deficiency anemia (n = 5). Prior to capsule endoscopy, 6 of 7 patients had bidirectional endoscopies and one had gastroscopy. All prior investigations were normal or nondiagnostic. Two of 7 experienced capsule retention. Five of 7 underwent surgery. Four patients died, giving a 5-year survival rate of 42.9 %. Conclusion Small bowel malignancies diagnosed by capsule endoscopy are rare, and the median age of 50 indicates they are more common in relatively younger patients. Capsule endoscopy is effective at diagnosing a rare malignancy when other imaging modalities have failed.

Su1149 Sham Feeding With Bacon Does Not Alter Small Bowel Transit Time or Complete Examination Rate in Patients Undergoing Capsule Endoscopy; Final Results of a Prospective Randomized Single Blinded Controlled Trial

Su1149 Sham Feeding With Bacon Does Not Alter Small Bowel Transit Time or Complete Examination Rate in Patients Undergoing Capsule Endoscopy; Final Results of a Prospective Randomized Single Blinded Controlled Trial

Capsule endoscopy in small bowel Crohn's disease and Tuberculosis.

Differentiation of small bowel tuberculosis (SBTB) from Crohn's disease (CD) is a diagnostic challenge. We studied 52 patients with suspected SBTB or CD with terminal ileal involvement, who were prospectively enrolled. After confirming patency of the gastrointestinal tract, 26 patients underwent capsule endoscopy (CE). A final diagnosis of CD was found in 18 patients and SBTB in eight patients. All SBTB patients had involvment of the ileocecal valve (ICV) with large (n = 6) and aphthous (n = 2) ulcers in the ileal segment. In CD, ICV involvement was seen in five (33%) patients. Large and aphthous ulcers were observed in seven (47%) and 15 (100%) patients, respectively. On comparison with CD, patients with SBTB had increased frequency of ICV involvement ( P = 0.002) and lesser frequency of aphthous ulcers ( P = 0.007). CE can help in differentiating CD from SBTB by the position of its involvement and the type of ulcers present.

Polyethylene Glycol for Small Bowel Capsule Endoscopy.

Capsule endoscopy has been the first-line examination for small bowel diseases, yet its diagnostic yield is restricted by unsatisfactory bowel preparation. To evaluate the clinical effectiveness of different dosages of polyethylene glycol in patients undergoing capsule endoscopy, we performed a comprehensive meta-analysis of all randomized controlled trials involving polyethylene glycol in preparation for capsule endoscopy. The methodological quality of the trials was evaluated using the Cochrane Risk of Bias assessment instrument. In this study, 12 RCTs involving 2072 patients were included in this review. Our review indicated that 4 L and 2 L polyethylene (PEG) before capsule endoscopy (CE) and 500 mL PEG after CE increase the small bowel image quality, whereas 1 L PEG did not improve the small bowel image quality. PEG accelerated the gastric emptying time. There was no significant difference between the PEG group and control group in small bowel transit time, completion rates, and diagnostic yield.

Assessment of serum angiogenic factors as a diagnostic aid for small bowel angiodysplasia in patients with obscure gastrointestinal bleeding and anaemia.

AIMTo assess the use of serum levels of angiopoietin-1 (Ang1), Ang2 and tumor necrosis factor-α (TNFα) as predictive factors for small bowel angiodysplasia (SBA).METHODSSerum samples were collected from patients undergoing capsule endoscopy for any cause of obscure gastrointestinal bleeding (OGIB) or anaemia. Based on small bowel findings patients were divided into 3 groups: (1) SBA; (2) other bleeding causes; and (3) normal, according to diagnosis. Using ELISA technique we measured serum levels of Ang1, Ang2 and TNFα and compared mean and median levels between the groups based on small bowel diagnosis. Using receiver operator curve analysis we determined whether any of the factors were predictive of SBA.RESULTSSerum samples were collected from a total of 120 patients undergoing capsule endoscopy for OGIB or anaemia: 40 with SBA, 40 with other causes of small bowel bleeding, and 40 with normal small bowel findings. Mean and median serum levels were measured and compared between groups; patients with SBA had significantly higher median serum levels of Ang2 (3759 pg/mL) compared to both other groups, with no significant differences in levels of Ang1 or TNFα based on diagnosis. There were no differences in Ang2 levels between the other bleeding causes (2261 pg/mL) and normal (2620 pg/mL) groups. Using Receiver Operator Curve analysis, an Ang2 level of > 2600 pg/mL was found to be predictive of SBA, with an area under the curve of 0.7. Neither Ang1 or TNFα were useful as predictive markers.CONCLUSIONElevations in serum Ang2 are specific for SBA and not driven by other causes of bleeding and anaemia. Further work will determine whether Ang2 is useful as a diagnostic or prognostic marker for SBA.

A prospective study of fecal calprotectin and lactoferrin as predictors of small bowel Crohn's disease in patients undergoing capsule endoscopy

Background: Capsule endoscopy (CE) is often used to investigate small bowel Crohn's disease (CD).Aim: The aim of this study is to prospectively assess the value of fecal calprotectin and lactoferrin to predict CE findings.Patients and methods: Sixty-eight consecutive patients that were referred for CE were included. Stool samples for calprotectin and lactoferrin and blood samples were collected for relevant parameters. Correlation between fecal markers and CE findings was assessed and receiver operating characteristic (ROC) curves were built to determine the predictive values of fecal markers for the diagnosis of CD.Results: Fecal calprotectin data was available for all the patients and lactoferrin data for 38. CE findings compatible with CD were found in 23 (33%) patients and 45 (67%) were negative for CD. The average age of the CD group was 34 compared to 46 in the non-CD group (p = .048). Median calprotectin and lactoferrin in the CD group and in the control group were 169 mg/kg vs. 40 (p = .004) and 6.6 mg/kg vs. 1 (p = .051), respectively. The area under the ROC curve was 0.767 for calprotectin and 0.70 for lactoferrin. A fecal calprotectin concentration of 95 mg/kg and fecal lactoferrin of 1.05 mg/kg had a sensitivity, specificity, positive predictive value and negative predictive value of 77 and 73%, 60 and 65%, 50 and 50%, and 84 and 84% in predicting CE findings compatible with CD.Conclusions: Fecal markers are simple and noninvasive surrogates for predicting CE findings compatible with CD. Fecal markers can help determine which patients should be referred for CE.ClinicalTrials.gov Identifier: NCT01266629

PTU-011 Small Bowel Malignancy in Patients Undergoing Capsule Endoscopy in A Tertiary Care Academic Institution

Introduction Cancer of the small-bowel (SB) is rare accounting for Methods Retrospective study; the records of all patients who underwent SBCE at our centre from Mar 2005 – Oct 2015 were reviewed; we retrieved those whose CEs were reported as suggestive of neoplasia. Further data was gathered on preceding and subsequent investigations, management and outcome of these patients. Results From a total of 1949 CE studies (1082 PillCamTM/867 MiroCamTM), SB neoplasia was diagnosed in 7 patients (0.36%; 2 F/5 M; median age 50, range 34–67). Two had lymphoma, 2 gastrointestinal stromal tumours (GIST), 2 duodenal adenocarcinomas, 1 jejunal metastasis from a sarcomatoid lung tumour. In these patients, CE was performed for: iron-deficiency anaemia (IDA) (n = 5), diarrhoea (n = 1) & suspicion of SB lymphoma (n = 1). 6/7 patients had prior negative bidirectional GI endoscopies; 1 had a normal gastroscopy. Prior to CE, two patients had abdominal USS, 4 had CT scan, 2 had SB follow-through and 1 had a bone marrow aspirate. Two patients had capsule retention; one was removed with a gastroscope, the other with push enteroscopy. All 7 patients had further investigations after CE. Six had a chest, abdomen & pelvis CT scan for staging. Two patients had push enteroscopy, both of whom were diagnosed with duodenal adenocarcinoma. One had double balloon enteroscopy (DBE), two had colonoscopy, two had UGIE; there was one abdominal USS and one bone marrow aspirate. Four pts underwent SB resection. Following resection, 1 patient with GIST had imatinib chemotherapy. Of the two individuals with duodenal adenocarcinoma, one underwent gastroenterostomy and the other had an elective Whipple procedure. Four patients passed away. Two remain under follow up with oncology and one with the GI team. Conclusion SB cancers are rare and our experience is in agreement with other studies. The median age of 50 indicates that SB malignancy is more common in relatively younger patients. Unexplained iron deficiency anaemia was the main presenting complaint in our patients which triggered further investigation despite negative bidirectional endoscopies. CE is effective in picking up SB neoplasia where other imaging modalities have failed. References 1 Schottenfeld D, Beebe-Dimmer JL, Vigneau FD. The epidemiology and pathogenesis of neoplasia in the small intestine. Ann Epidemiol 2009;19:58–69. 2 Pennazio M, Rondonotti E, de Franchis R. Capsule endoscopy in neoplastic diseases. World J Gastroenterol 2008;14:5245–53. 3 Pennazio M, Spada C, Eliakim R, et al. Small-bowel capsule endoscopy and device-assisted enteroscopy for diagnosis and treatment of small-bowel disorders: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline. Endoscopy 2015;47:352–86. 4 Rondonotti E, Pennazio M, Toth E, et al. Small-bowel neoplasms in patients undergoing video capsule endoscopy: a multicenter European study. Endoscopy 2008;40:488–95. Disclosure of Interest C. Johnston: None Declared, D. Yung: None Declared, A. Koulaouzidis Grant/research support from: ESGE- Given®Imaging Research grant 2011, J. Plevris: None Declared

Clinical Utility of Patency Capsule in Pediatric Video Capsule Endoscopy

Introduction: Capsule Endoscopy retention is a concern among pediatric patients who undergo video capsule endoscopy. The patency capsule(PC) has been used to determine small bowel patency. An abdominal x-ray is often used to determine if the PC has passed through the small bowel within 30 hrs. We report our experience of the use of the agile patency capsule in pediatric capsule endoscopy. Methods: We retrospectively reviewed the use of the (PC) in our cohort of 528 pediatric patients undergoing capsule endoscopy. There were 86 patency capsules performed. Patients ingested the patency capsule 30 hours prior to obtaining an abdominal x-ray. The abdominal x-ray was read by radiologists and also by the gastroenterologist performing the capsule endoscopy study. The indications for the patency capsule evaluation included known Crohn's disease 38 (44.2%) and Ulcerative Colitis 5 (5.81%). Results: 86 patients underwent patency capsule study along with and abdominal x-ray prior to capsule endoscopy. In 40 (46.5%) of abdominal x-rays, the PC was not seen at 30 hours post ingestion, confirming complete passage throgh the GI tract. In 44 (51.2%) abdominal x-rays, the radiologist reported presence of the PC in the abdomen. In 27(31.4%) of these 86 x-rays where the PC was noted in the abdomen, the radiologist commented that the PC was in the colon. In 15 (17.4%) abdominal x-rays, the location of the PC was not specifically identified to be within the colon. Instead, it was reported to be in various locations such as the right lower quadrant. The gastroenterologist therefore was required to further interpret these x-ray studies to determine whether these 15 PCs were in the colon. In 2 (2.3%) abdominal x-rays studies, the radiologist interpreted the capsule to be in the distal ileum or cecal region. These PC's were confirmed by colonoscopy to be retained in the distal ileum. Capsule endoscopy was therefore not performed on these two patients. The remaining 84 patients sucessfully completed video capsule endoscopy. The patency capsule retention rate within the small bowel at 30 hours post injestion was found to be 2.3% of patency capsule studies. Conclusion: The patency capsule is useful in preventing capsule endoscope retention and often requires careful interpretation by both the radiologist and the gastroenterologist.Figure 1Figure 2

Sporadic small bowel tumors detected by capsule endoscopy in patients with occult gastrointestinal bleeding.

Intestinal tumors represent less than 6% of digestive tumors, and, because of the limitations of intestinal investigations, these tumors are difficult to diagnose. In this context, capsule endoscopy has proven effective, especially in patients with obscure digestive bleeding. In a large series of patients undergoing capsule endoscopy, small bowel tumors are found in 2.4-8.9% of cases. The aim of this retrospective, single-center study, based on prospective database, is to evaluate the frequency of small bowel tumors detected by capsule endoscopy in patients with occult gastrointestinal bleeding. During 2004-2014, 849 consecutive patients underwent CE at our Department for occult gastrointestinal bleeding. Following capsule endoscopy, the medical records of the study population were reviewed. Results of double-balloon enteroscopy or surgery performed after capsule endoscopy were retrieved. Capsule endoscopy identified 55 small bowel tumors (6.5%), of which 28 malignancies (51%) and 27 benign neoplasms (49%) underwent surgery or endoscopic treatment. Malignancies included adenocarcinoma (18.7%), gastrointestinal stromal tumors (GIST) (12%) and lymphoma (6.7%). Benign neoplasms included dysplastic adenomatous polyps (36%) and hyperplastic polyps (25.3%). Non-neoplastic masses included one inflammatory polyp. Capsule retention occurred in four patients (5.3%) and the retained capsule was retrieved during surgery. In our experience neoplasms of small bowel are found in 6.5% of patients with occult gastrointestinal bleeding. Of these malignancies, small bowel neoplasms are found in 3.3% of cases. Capsule endoscopy is an effective and sensitive diagnostic tool, and plays an important role in the algorithm for the diagnostic workup of suspected small bowel tumors.

Jejunal diverticulosis found in a patient with long-standing pneumoperitoneum and pseudo-obstruction on imaging: a case report.

Small bowel diverticulosis is a rare finding within the general population and jejunal diverticulosis, specifically, is even rarer. Clinical manifestations can range from post-prandial pain, constipation and malabsorption to serious complications, such as gastro-intestinal hemorrhage, perforation and acute intestinal obstruction. Here we describe the case of an 81-year-old gentleman who presented with a three-year history of abdominal pain and weight loss. Despite unremarkable physical examination and laboratory tests, persistent pneumoperitoneum and dilated loops of small bowel were found on imaging. Having been given a diagnosis of small bowel bacterial overgrowth, the patient underwent capsule endoscopy study for further evaluation of his small bowel. The capsule did not reach the colon and the patient never noted passing the capsule in his stool so, six months post-procedure, a computed tomography (CT) scan seemed to reveal the retained capsule. Subsequent exploratory laparotomy revealed 200 cm of atonic, dilated jejunum with impressive diverticula along the anti-mesenteric border. This case report is an example of an unusual set of presenting signs and symptoms of jejunal diverticulosis, including persistent pneumoperitoneum, pseudo-obstruction and small bowel bacterial overgrowth. A literature review has revealed that these signs have been present in other cases of jejunal diverticulosis, although the etiology and pathophysiology is not clearly understood.